Provider Demographics
NPI:1548424831
Name:ALTERNATIVE CREATIVE THERAPY
Entity Type:Organization
Organization Name:ALTERNATIVE CREATIVE THERAPY
Other - Org Name:SANDI HODGES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDI
Authorized Official - Middle Name:GALE
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:540-484-6996
Mailing Address - Street 1:2600 OLD FRANKLIN TPKE
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-5676
Mailing Address - Country:US
Mailing Address - Phone:540-484-6996
Mailing Address - Fax:540-484-6935
Practice Address - Street 1:2600 OLD FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-5676
Practice Address - Country:US
Practice Address - Phone:540-484-6996
Practice Address - Fax:540-484-6935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003548302F00000X, 302R00000X, 305R00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1518643406OtherFAMIS
VA11526350OtherCAQH
2117903OtherMAMIS
VA4634562OtherSENTARA
VA1518943406Medicaid
VA2190356OtherCIGNA
VA247544OtherSOUTHEASTERN SERVICES
VA1518943406OtherVIRGINIA PREMIER
VA247544OtherBLUE CROSS/BLUE SHIELD
VA600059283OtherMEGELLAN
VA0701003548OtherVIRGINIA STATE BOARD OF COUNSELING
VA1332930OtherCOMPSYCH
VA62-02411OtherUNITED BEHAVIORAL